Published byStanford Medicine

Mental Health

I’m currently pregnant and due in less than two weeks. It’s my second child, so I’m not as worried about caring for a newborn as I was the first time around. But one nagging worry I have is the risk of postpartum depression, sometimes called postnatal depression. I have a family history of depression and that puts me at higher risk. Luckily, it wasn’t a problem with my firstborn, but it can crop up in later pregnancies – and scientists don’t entirely understand the reasons for it.

Postpartum depression usually hits four to six weeks after delivery—though it can show up months later. It’s characterized by feeling overwhelmed, trapped, guilty or inadequate, along with crying, irritability, problems concentrating, loss of appetite or libido, or sleep problems. An estimated 9 to 16 percent of new mothers are affected by postpartum depression. Even men are known to suffer from it sometimes. PPD affects not just the mother (or father), but can have lasting effects on the child as well, so helping these parents through a difficult and isolating time is critical

Now, a study published in Journal of Advanced Nursingshows that providing a social network for new moms, via phone calls from other mothers who had recovered from PPD, could alleviate symptoms for moms in the study for up to two years after delivery. A news release summarized the findings:

For the present quasi-experimental study, researchers recruited 64 mothers with depression up to two years after delivery who were living in New Brunswick. Peer volunteers who recovered from postnatal depression were trained as peer support and provided an average of nine support calls. The average age of mothers was 26 years, with 77% reporting depressive symptoms prior to pregnancy and 57% having pregnancy complications. There were 16 women (35%) who were taking medication for depression since the birth.

I find the idea that this insidious problem could be tackled with a phone version of the ubiquitous and valuable moms’ groups an uplifting one. Compared to drug treatments, regular phone calls from a peer who’s gone through something similar is a relatively cheap treatment. Further studies are needed, but I’ll be watching to see whether this approach takes hold as a standard intervention for PPD.

Any serious loss requires grieving time, and the birth of stillborn child is no exception. However, a recent study suggests that women who have experienced a stillbirth should be monitored for depressive symptoms well after the standard six-month grieving period – up to three years, in fact. Among women who have given birth and who have no history of depression, women who have had a stillbirth are at significantly higher risk of developing long-term depression.

The research was conducted by the NIH’s Stillbirth Collaborate Research Network (SCRN), which defines stillbirth as the death of a baby at or after the 20th week of pregnancy. It occurs in 1 out of 160 pregnancies in the United States, a surprisingly high ratio.

This study is the first to show definitively that women who have no history of depression may face a risk for it many months after a stillbirth

From 2006-2008, the researchers enrolled nearly 800 women from 59 hospitals across the U.S., around a third of whom had delivered a stillbirth (with the other two-thirds having had delivered a healthy baby). In 2009, the women were asked to complete a questionnaire designed to gauge whether they were experiencing symptoms of depression.

After accounting for other factors related to depression and stillbirth among the more than 76 percent of women who did not have a history of depression, the researchers found that women who had a stillbirth were twice as likely to have a high depression score compared to women who had a live birth. This difference was even greater among those responding to the questionnaire 2-3 years after they had delivered, at nearly nine times as likely.

In an NIH article, author Carol Hogue, PhD, director of the Women’s and Children’s Center at Emory University’s Rollins School of Public Health in Atlanta and first author of the study, said, “Earlier studies have found that women with a history of depression are especially vulnerable to persistent depression after a stillbirth, even after the subsequent birth of a healthy child,” but this study is the first to show definitively that women who have no history of depression may face a risk for depression many months after a stillbirth.

The study appears in the March issue of the journal Paediatric and Perinatal Epidemiology.

Confession: I named my parents’ cat (who died recently) Watson after listening to Ira Flatow interview James Watson, PhD, while driving cross country with my dad in 2000. Both before and after the all-critical cat-name-inspiring program, Science Friday has been a part of my Friday as often as I can squeeze it in.

Greicius, medical director of the Stanford Center for Memory Disorders, has worked with the gene variant known as ApoE4 – the largest single genetic risk factor for Alzheimer’s, particularly for women. Last spring, he published a study showing that healthy ApoE4-positive women were twice as likely to contract the disease as their ApoE4-negative counterparts.

Greicius is expected to be on in the second hour, from 12 to 1 p.m. Pacific time.

Having a baby is a huge life alteration – who wouldn’t be at least a bit anxious? The vast majority of women experience mood shifts surrounding pregnancy: Around 80 percent experience “baby blues,” and in up to 20 percent this develops into something more serious. But most of these women go untreated, and many undiagnosed.

The California Maternal Mental Health Collaborative (which is changing its name to “The 2020 Mom Project” as they expand outside California) is spearheading efforts to get the word out about perinatal mood disorders. Last Friday, they hosted a seminar on emerging considerations in maternal mental health. As a birth doula, I was particularly happy to listen in. The keynote speakers approached the issue from a pointedly broad perspective, considering the social, economic, and cultural factors that influence health problems and care provision. The take-home message was that to address perinatal mood disorders, we need to address the context in which they happen, including protecting tomorrow’s moms while they are children today.

Vincent Felitti, MD, professor of medicine at UC San Diego and founder of the California Institutes of Preventive Medicine, has done extensive research on how “adverse childhood experiences” affect health by correlating an “ACE score” of self-reported negative experiences such as abuse, neglect, or household dysfunction with incidence of disease. The top-10 causes of death in the U.S. are strongly correlated with high ACE scores. Moreover, so are their risk factors! Much abuse of alcohol, drugs, and food is a coping mechanism for prior traumas. “What we see as the problem turns out to be somebody’s solution to problems we know nothing about,” Feletti said. “Depression is considered a disease, but what if it was a normal response to adverse life experiences? ACE score statistics support this.”

In a similar vein, Calvin Hobel, MD, an obstetrician-gynecologist at Cedars Sinai Medical Center in Los Angeles, spoke about how maternal stress surrounding pregnancy causes complications and adverse child outcomes, including premature birth. Stress causes uterine irritability, which causes cervical changes that favor pre-term delivery. It signals to the placenta that things aren’t going well, and the baby better get out early. Just as soldiers with stressful backgrounds are more at risk for PTSD, moms who’ve had a rough life are more stress-reactive and less prepared to cope with the demands of motherhood.

It’s time for Biomed Bites, a weekly feature that introduces readers to some of Stanford’s most innovative researchers.

Looking out my window, I see a man dressed in red sweats on a bike. There’s my neighbor’s white truck parked in the street. A tree just starting to bud. A fire hydrant. A woman fertilizing roses. Closer, there’s my grey-and-white cat, Grizzly, bathing in the sun. My glass of ice water. My phone. Scattered papers.

And that’s probably only one-thousandth of the things I see right now. (I didn’t even mention the computer.) How do I make sense of that visual onslaught? How do I navigate, perceive threats, respond to changing conditions?

Well, that’s part of the puzzle Stanford neurobiologist Tirin Moore, PhD, is working to figure out.

“I’m a systems-level neurobiologist, which means I study how networks of neurons combine to either process sensory information or to control complex behaviors,” Moore explains in the video above.

How do we filter out what’s important – seeing the dog darting across the street in front of our car, but not focusing on the bird in the tree?

This process is most obvious when it breaks down, such as in patients with Attention Deficit Hyperactivity Disorder, or other attention disorders that affect from 3 to 8 percent of the population, Moore said:

At present, disorders such as ADHD are treatable, but their underlying neural basis is still very much a mystery… Our hope is that by understanding disorders of attention at the level of the neurocircuitry we will be able to arrive at more effective treatments…

Stay tuned to see what he, and his team, figures out.

Learn more about Stanford Medicine’s Biomedical Innovation Initiative and about other faculty leaders who are driving biomedical innovation here.

Psychiatric disorders, traditionally distinguished from one another based on symptoms, may in reality not be as discrete as we think.

In a huge meta-analysis just published in JAMA Psychiatry, Stanford neuroscientist and psychiatrist Amit Etkin, MD, PhD, and his colleagues pooled the results from 193 different studies. This allowed them to compare brain images from 7,381 patients diagnosed with any of six conditions – schizophrenia, bipolar disorder, major depression, addiction, obsessive-compulsive disorder, and a cluster of anxiety syndromes – to one another, as well as to brain images from 8,511 healthy patients.

Compared with healthy brains, patients in all six psychiatric categories showed a loss of gray matter in each of three separate brain structures. These three areas, along with others, tend to fire in synchrony and are known to participate in the brain’s so-called “executive-function network,” which is associated with high-level functions including planning, decision-making, task-switching, concentrating in the face of distractions, and damping counterproductive impulses.

The findings call into question a longstanding tendency to distinguish psychiatric disorders chiefly by their symptoms

(“Gray matter” refers to information-processing nerve-cell concentrations in the brain, as opposed to the “white matter” tracts that, like connecting cables, shuttle information from one part of the brain to another.)

As Etkin told me when I interviewed him for the news release we issued on this study, “these three structures can be viewed as the alarm system for the brain.” More from our release:

“They work together, signaling to other brain regions when reality deviates from expectations – that something important and unpredicted has happened, or something important has failed to happen.” That signaling guides future behavior in directions more likely to obtain desired results.

The studies of psychiatric patients that Etkin’s team employed all used a technique that yields high-resolution images of the brain’s component structures but can say nothing about how or when these structures work or interact with one another. However, that kind of imaging data was available for the healthy subjects. And, on analysis, those healthy peoples’ performance on classic tests of executive-function (such as asking the test-taker to note the color of the word “blue,” displayed in a color other than blue, after seeing it briefly flashed on a screen) correlated strongly with the volume of gray matter in the three suspect brain areas, supporting the idea that the anatomical loss in psychiatric patients was physiologically meaningful.

The findings call into question a longstanding tendency to distinguish psychiatric disorders chiefly by their symptoms rather than their underlying brain pathology – and, by implication, suggest that disparate conditions may be amenable to some common remedy.

As National Institute of Mental Health Director Thomas Insel, MD, told me in an interview about the study, the Stanford investigators “have stepped back from the trees to look at the forest and see a pattern in that forest that wasn’t apparent when you just look at the trees.”

As a medical student, Sergiu Pasca was frustrated when he learned about the treatments available for mental disorders such as autism and schizophrenia.

“We can cover up the symptoms, but these are lifelong, chronic disorders,” Pasca, MD, said. “That was incredibly disappointing to me.”

Now, as a neuroscientist, Pasca is planning to do something about that. To understand more about the mechanisms driving these disorders, his team has developed a technique to take cells from patients with schizophrenia and culture them in a dish to make functional 3-D neural models. Using this approach, his team is trying to uncover the roots of schizophrenia.

What is going wrong during neural development that leads to these disorders? Are the neurons themselves misformed? What is the role of glial cells, the under-appreciated support cells in the brain?

The technique offers opportunities not available by examining post-mortem human brains or living mice, whose neurons are quite different than humans’, Pasca said.

The mental-health community is excited about this new technique too; Pasca was recently named one of four MQ Fellows, an honor bestowed by a London-based NGO that works to improve the quality of life for people with mental-health disorders. The fellowship provides more than $350,000 over three years as well, enough to support Pasca’s relatively new Stanford lab.

As a parent, this Time headline immediately grabbed my attention: “Mindfulness Exercises Improve Kids Math Scores.” But as I read the article, I learned that math scores were just one facet examined by the researchers and that mindfulness training was also shown to help children be less stressed and more caring.

The study, which was published in this month’s issue of Developmental Psychology, looked at a group of 99 fourth and fifth graders in British Columbia. For four months, half of the students were taught a pre-existing “personal responsibility” curriculum, while the rest learned about mindfulness through a program called MindUP that focuses on breathing exercises, mindful smelling and eating, and gratitude. The researchers then looked at cortisol levels, behavioral assessments, self-reports, along with those math scores. The article describes the results in more detail:

The results were dramatic. “I really did not anticipate that we would have so many positive findings across all the multiple levels we looked at,” says study co-author Kimberly A. Schonert-Reichl, a developmental psychologist at the University of British Columbia. “I was very surprised,” she says—especially considering that the intervention took place at the end of the year, notoriously the worst time for students’ self-control.

Compared to the kids in the social responsibility program, children with the mindful intervention had 15% better math scores, showed 24% more social behaviors, were 24% less aggressive and perceived themselves as 20% more prosocial. They outperformed their peers in cognitive control, stress levels, emotional control, optimism, empathy, mindfulness and aggression.

While at the World Economic Forum annual meeting in Davos, neuroscientists Tony Wyss-Coray, PhD, and Amit Etkin, MD, PhD, had a webcast conversation with NPR correspondent Joe Palca as part of his series of conversations on brain science. During their conversation, Palca asked about the current state of treatment for mental health and neurodegenerative diseases (bad) and prospects for the future (better).

When asked the single most important thing people could do for their mental health, Etkin answered, “awareness”. He said people need to be aware of their mental health and know that help exists if they seek it out. Current treatments aren’t perfect, but they are better than no treatment at all.

At the end, Palca summarized the wide-ranging conversation saying, “I think it’s a time of actually some hope. I feel quite positive that this globby thing that sits inside our skulls is being understood in enough detail to make some precise changes that can be helpful.”

Four faculty from the Stanford Neurosciences Institute have been in Davos for the past few days attending the World Economic Forum along with world leaders and economic illuminati. They were invited to form a panel about the recently announced Big Ideas in Neuroscience, which is a novel way of bringing faculty together around health challenges like stroke, neurodegenerative disease and mental health conditions. If this approach is successful it could help ease the crippling economic and emotional costs of those diseases.

Amit Etkin, MD, PhD, emailed me from the conference that attendees seem to be very excited and focused on the sessions, with lines out the door of people waiting for seating. The entire panel included Etkin, who co-leads a mental health team, Marion Buckwalter, MD, PhD, who leads a stroke collaboration, and Tony Wyss-Coray, PhD, and Anne Brunet, PhD, who are both part of the neurodegenerative disease team.

Tomorrow at 6 a.m. Pacific Time both Etkin and Wyss-Coray will be webcast live in conversation with NPR correspondent Joe Palca. That webcast is available on the World Economic Forum website.